Vicheva Petya, Osborne Curtis, Krieg Sandro M, Ahmadi Rezvan, Shotbolt Paul
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Medical Faculty Heidelberg, Department of Neurosurgery, University Heidelberg, Heidelberg, Germany.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Prog Neuropsychopharmacol Biol Psychiatry. 2025 Jan 10;136:111147. doi: 10.1016/j.pnpbp.2024.111147. Epub 2024 Sep 16.
Transcranial magnetic stimulation (TMS) is a safe non-invasive treatment technique. We systematically reviewed randomised controlled trials (RCTs) applying TMS in obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) to analyse its therapeutic benefits and explore the relationship between cortical target and psychopathophysiology. We included 47 randomised controlled trials (35 for OCD) and found a 22.7 % symptom improvement for OCD and 29.4 % for PTSD. Eight cortical targets were investigated for OCD and four for PTSD, yielding similar results. Bilateral dlPFC-TMS exhibited the greatest symptom change (32.3 % for OCD, N = 4 studies; 35.7 % for PTSD, N = 1 studies), followed by right dlPFC-TMS (24.4 % for OCD, N = 8; 26.7 % for PTSD, N = 10), and left dlPFC-TMS (22.9 % for OCD, N = 6; 23.1 % for PTSD, N = 1). mPFC-TMS showed promising results, although evidence is limited (N = 2 studies each for OCD and PTSD) and findings for PTSD were conflicting. Despite clinical improvement, reviewed reports lacked a consistent and solid rationale for cortical target selection, revealing a gap in TMS research that complicates the interpretation of findings and hinders TMS development and optimisation. Future research should adopt a hypothesis-driven approach rather than relying solely on correlations from imaging studies, integrating neurobiological processes with affective, behavioural, and cognitive states, thereby doing justice to the complexity of human experience and mental illness.
经颅磁刺激（TMS）是一种安全的非侵入性治疗技术。我们系统回顾了将TMS应用于强迫症（OCD）和创伤后应激障碍（PTSD）的随机对照试验（RCT），以分析其治疗效果，并探讨皮层靶点与心理病理生理学之间的关系。我们纳入了47项随机对照试验（35项针对OCD），发现OCD症状改善率为22.7%，PTSD为29.4%。针对OCD研究了8个皮层靶点，针对PTSD研究了4个皮层靶点，结果相似。双侧背外侧前额叶皮质TMS（dlPFC-TMS）表现出最大的症状变化（OCD为32.3%，N = 4项研究；PTSD为35.7%，N = 1项研究），其次是右侧dlPFC-TMS（OCD为24.4%，N = 8；PTSD为26.7%，N = 10），以及左侧dlPFC-TMS（OCD为22.9%，N = 6；PTSD为2３.1%，N = 1）。内侧前额叶皮质TMS（mPFC-TMS）显示出有前景的结果，尽管证据有限（OCD和PTSD各有2项研究），且PTSD的研究结果相互矛盾｡尽管有临床改善，但综述报告缺乏关于皮层靶点选择的一致且可靠的理论依据，揭示了TMS研究中的一个空白，这使得研究结果的解释变得复杂，并阻碍了TMS的发展和优化。未来的研究应采用假设驱动的方法，而不是仅仅依赖于影像学研究的相关性，将神经生物学过程与情感、行为和认知状态整合起来，从而公正地对待人类体验和精神疾病的复杂性。
